Volume 3 Issue 2 - 2010

Revalidation – a topic that has been widely discussed and written about over the last few years. However it is turning into a huge project and there are rumours that the DOH is not happy with the large costs associated with this project. No doubt by now most of you will have had your ‘licence’ from the GMC, which is an essential part of revalidation. This is the relatively straight forward part. ENT UK and the Royal Colleges have been busy lobbying the DOH to try and ensure that revalidation remains a sensible process and let us hope that they are successful. The current consensus is that the ‘responsible officer’ (usually the medical director) will make a recommendation every 5 years to the GMC based on a robust local, compulsory appraisal process. The more ‘hard’ evidence you can provide, the better.

Endoscopic sinus surgery (ESS) is the mainstay of surgical management for sinus pathology in the modern age. The most common reason for performing ESS is for chronic rhinosinusitis, with or without polyp disease. However, the extended applications of ESS include closure of CSF leaks, resection of sinonasal tumours, nasolacrimal duct surgery, orbital decompression, and a means of approach to the skull base and intracranial cavity. The proximity of these important anatomical areas to the paranasal sinuses correlates with the types of complications associated with ESS.


Normal balance function relies on information from vision, somatosensory input and the peripheral vestibular system. This sensory information is integrated, modulated and interpreted within the central nervous system to enable gaze stabilization together with information regarding self and environmental movement. Interpretation requires cross referencing of sensory information with previously generated templates. A mismatch results in symptoms of “dizziness”, “unsteadiness” or “vertigo”.

Patients with dizziness are effectively and efficiently managed by otolaryngologists. Our specialty lends itself to the management of the majority of pathologies resulting in vertigo, although surgical intervention is seldom required. We discuss a multidisciplinary team model in addition to a brief description of common vestibular conditions and their treatment.


MELAS (mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes) is a rare syndrome that can elude the unsuspicious surgeon or physician. The presentation is often non-specific and diagnosis requires a high index of suspicion in addition to a detailed history, examination and investigations. It often contributes to hearing loss and must therefore be borne in mind when assessing young patients with this complaint.


Aim: To review the literature on the association between migraine and dizziness, and to provide a system for differentiating vestibular migraine from other causes of dizziness.

Method: A PubMed search using the words ‘migraine’, ‘dizziness’, ‘vestibular migraine’ and ‘migrainous vertigo’ was conducted.


Hereditary resorption of endochondral bone and disordered deposition of bone localised to the otic capsule.1


Estimates vary but histological evidence of otosclerosis has been demonstrated in up to 10% of Caucasians;2 more recent studies suggest this may be an overestimate, with the true figure between 2.5- 4%.3 Approximately 2% of the British population are symptomatic.4


Cholesteatoma is a common problem encountered in otolaryngology clinics around the world. The true incidence of acquired cholesteatoma is not known but retrospective studies from Europe have suggested a mean incidence of 9.2 per 100,000.1,2 Although an important problem, the aetiology and management of cholesteatoma are shrouded in controversy. It is therefore of little surprise that there is much debate on the indications, timing or modality of imaging used in the diagnosis and monitoring of patients with cholesteatoma. It is the aim of this article to iron out some of this controversy by identifying some of the benefits of different imaging modality choices and discussing recent developments in the field. The choice of imaging strategy differs greatly between those patients who present with a new diagnosis of suspected cholesteatoma and those who have previously undergone surgery. In order to address this, the imaging strategies used for pre-operative and post-operative cholesteatoma have been presented separately.

We continue in the same vein as previous examples depicting common intercollegiate viva topics. Often questions start with a clinical scenario, but equally pictures may be presented to you either in the form of a print or on a laptop depicting various clinical signs. Since each viva lasts 30mins, 15 mins are allocated to each of the two examiners. On average 3 topics are covered by each examiner. Initial questions are always straight forward and aim to get you settled and more relaxed. Competency questions are always asked looking to see that you are safe in your thinking and management. You must answer these correctly. The examples given are only a guide to viva technique, but it is important to practice and to develop a system that you are comfortable with.


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